Abstract
It can be stated that there is no leprosy without nerve damage. Most of this damage takes place during exacerbations of the disease called reactions. There are two main types of reactions: type 1 leprosy reaction (T1R) and type 2 leprosy reaction (T2R). T1R complicates the course of borderline leprosy, namely borderline tuberculoid (BT), mid-borderline (BB), and borderline lepromatous (BL) leprosy. It is related to increase of the patient’s cell-mediated immunity against M. leprae antigenic determinants. Clinically it is characterized by signs and symptoms of neuritis and increased inflammation of existing skin lesions. Its treatment is based on immunosuppression by means of prednisolone. T2R occurs in BL, subpolar lepromatous (LLs), and polar lepromatous (LLp) leprosy. It is related to imbalance of cellular immunity and humoral immunity, leading to the formation of immune complexes. T2R is a generalized disease, with many organs and tissues involved. Its most common manifestation is episodic, self-limiting, recurrent eruption of tender, erythematous nodules. The treatment is based on use of thalidomide, prednisolone, and clofazimine. Severe reactions are the only common medical emergencies in leprosy; they need to be diagnosed and treated in a timely fashion to prevent peripheral nerve damage and permanent disability.
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